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P - 43149Building BUILDING Permit No.: ��61t� � � � ' Ins�,ections RESIDENTIAL APPLICATION Received B: ��.`' y�`°M' ►b3-572-3604 CITY OF FRIDLEY Da��'��'�a�+ `�� 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE ��' � , YO R E-MAIL ADDRESS SITE ADDRESS �X � D � � l� � THIS APPLICANT IS: �OWNER ❑CONTRACTOR ' PROPERTY OWNER/ NAME: �(AI� � QlJ R-L I�Y� �� NC TENANT ADDRESS: C%�j , R � L� ST CITY S PR %/� `"'� G/� STATE i� IP -3� PHONE: � ^ Y CONTRACTOR NAME: � S %t.►/t% SUBIvIIT A COPY OF STATE LICENSE # C � EXP DATE YOUR STATE LICENSE AND CERTTFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHO E FAX PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE '❑� DDITION ❑ GARAGE/SHED ❑ WINDOWS . �BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE � DECK ❑ SIDING D OTHER ❑ SWIMMING POOL TYPE OF WORK: O NEW HOME CONSTRUCI'ION _❑9DDIT[ON ❑ MAINTENANCFJREPAIR �(REMODELING DESCRIBE WORK BEING DONE: �� IV % S Sm r SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S k"f ROOFING p HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE �. Existing Floor Plan GARAGES O A7"fACHED GARAGE 2. Proposed floor pian PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: _, FOR NEW CONSTRUCTION [NCLUDING DECKS, inyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. _ _ __ _----- 2. Two sets of construction plans WINDOWS � 3. Energy Calculations IN EXISTING O INGS e No LOCATION O DOW� FOR WINDOWS — PROVIDE U-VALUE AND OR FORNEW OPE CRIBE SIZE OF � MANUFACNRE STICKER ON WINDOW. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASEll ON VALUA"1'1VN, 1NCLUD1Nli l riL�' CV�1' 1 Ul�' LABVK A1vL MA 11�;KlAL,; �(USING THE �997 U.B.0 FEE SCHEDULE) AL JOB VALUATION $ Sl J 5, r� O ti ______ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee SewerMain Chazge Total Due $ � ��j �, a 5 See Back Page for Fee Schedule $ 1la?� �� 65% of Building Permit Fee $ p' .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ ' $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ �!'�Y/1 Make checks uavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe d work is t to start without a permit on site; that the work will be in accordance with the approved plan in the case o r w' quires rev' and approval of plans. SIGNANRE OF APPLICA � PRINTNAME �� 5��Sl� � DATE S��v a n � � � d �� 2 � 1/� R � �� _ � �-' � � � ,� �.; � � �� ; � �� w � � � � � i � eti1 , .7�— � � ,� � � � � � � � � \ � � �� Q �. � � Y a �b V1 �. ; � 3 � � .li � �� j 5 _.._....,.._,. ..r....._._ _... .... ... _„ .�. . ... . ............... ,..0 �..v..�� ..., ..:_. ., .. .:.._,... � � � � � � � ,r�.- � D � ,w� � � � V V � ; �__... Ql.. Q ►---- T � , � d � � �9 -D� .0 � "" `� 6� , � � � � .� 't�; �i . � Un ? � � � � � Y► '�.. .. �,.. ' �� _._.Y..�.� .r ; d� i � � ' ; 7 __� , - -, ! � � � , I �-� � -�- �. � � � �� W �� (/b � � I � 'W � � � � � �, �'/ � ' � J �" 3 � � � � � � � �� ; n � `.._._ ... _ . . :._ .... . _..._ � � �� . . ,.,..+��...-..�.1�.,.. � � � � �� n V� � � --..� � '4 � •� � /�.-- ' 3 � /�" . ... .. ....m.. .,,.. � � Q r., Z �. �r.� v� �, � -- �: � � 1., �1!!� �a' � 2 �,� � ..�� - ` � � � � � — t:.�, ,` � � �; � �, � �� c� `y � •.:3 ��,:d �, � � �� • � �' n ' � � � � � � 1 I ; i �+ ,� c�